Two-wire protection of side branches to prevent side branch occlusion during stent implantation for bifurcational lesion
- PDF / 490,649 Bytes
- 5 Pages / 595.276 x 790.866 pts Page_size
- 26 Downloads / 146 Views
CASE REPORT
Two-wire protection of side branches to prevent side branch occlusion during stent implantation for bifurcational lesions Hirotaka Oda • Keiichi Tsuchida • Kazuki Okamura Kazuyuki Ozaki • Kazuyoshi Takahashi • Tsutomu Miida
•
Received: 4 September 2009 / Accepted: 29 November 2009 / Published online: 15 January 2010 Ó Japanese Association of Cardiovascular Intervention and Therapeutics 2010
Abstract To prevent side branch occlusion during bifurcational lesion stenting, the placement of a wire in both the main branch and side branch is performed for ‘‘sidebranch protection’’. However, this procedure does not always prevent side branch occlusion. A procedure for placing two wires in the side branch, called ‘‘two-wire protection of side branches’’, is considered to be more likely to prevent occlusion compared with one-wire protection of the side branch. We report on three cases in which ‘‘two-wire protection of side branches’’ was effectively performed during the stenting of bifurcational lesions. Keywords Bifurcational lesion Side branch occlusion Guide wire Side branch protection
Introduction The stenting of bifurcational lesions is still a challenging issue for percutaneous coronary intervention (PCI) because bifurcational lesions carry a high risk of cardiac enzyme elevation due to side branch occlusion or restenosis, despite the development of drug-eluting stents [1–3]. In cases of true bifurcational lesions, in which there is [50% narrowing of the diameters of both the main branch and the orifice of the side branch, implanting a stent in the main branch while it crosses over the orifice of the side branch often causes occlusion of the side branch [4]. To prevent
H. Oda (&) K. Tsuchida K. Okamura K. Ozaki K. Takahashi T. Miida Department of Cardiology, Niigata City General Hospital, 463-7 Shumoku, Chuo-ku, Niigata 950-1197, Japan e-mail: [email protected]
123
the side branch from being occluded, a procedure for stenting the main branch while also inserting a wire into the side branch, so-called ‘‘side-branch protection’’, is commonly performed. However, this procedure is not always effective, particularly in cases involving a severe stenosis of the side branch orifice. We report on a procedure involving the placement of two wires into a side branch to maintain its patency during stenting of the main branch.
Case report In the first case, there was a severe true bifurcational lesion in the mid portion of the left anterior descending artery (LAD), involving the ostium of the diagonal branch (Dx), which supplied blood to a moderately large area (Fig. 1a). Maintaining the patency of the Dx after stent implantation in the LAD across the ostium of the Dx was considered to be the optimal treatment method. To do this, we used a 7-French JL guide catheter. First, rotational ablation of the diffuse and calcified lesion of the LAD was performed using a burr measuring 1.5 mm in diameter because there was a risk that the plaque of the LAD lesion might move into the Dx ostium and oc
Data Loading...
